Serum ferritin predicts early mortality in patients with decompensated cirrhosis

Background & Aims: Serum ferritin is a known marker of hepatic necro-inflammation and has been studied to predict 1 year mortality and post-transplant survival in decompensated cirrhotics. However, there are no studies evaluating ferritin as a predictor of early mortality. We investigated whether serum ferritin levels could predict 15 day and 30 day mortality in patients with decompensated cirrhosis. Methods: 318 patients with decompensated cirrhosis were included. Results: Patients of decompensated cirrhosis [257 males, mean age of 51 [ +/- 13] years, were followed for a median of 31 days. Serum ferritin levels were significantly different between survivors and non-survivors [p <0.001] and showed significant correlation with MELD score [p <0.001], CTP score [p <0.001], leucocyte counts [TLC] [p <0.001], serum sodium [p <0.001], ACLF grades [p = 0.005], spontaneous bacterial peritonitis [SBP] [p = 0.02], hepatic encephalopathy [HE] [p <0.001] and hepatorenal syndrome [HRS] [p = 0.012]. Serum ferritin, etiology, MELD, HE, CTP score, sodium, TLC, and ACLF grades were significant predictors of mortality on univariate analysis. Ferritin [p = 0.04, HR 1.66 95% CI (1.02-2.73)] was a significant predictor of early mortality on multivariate analysis along with HE [p = 0.006, HR 3.47 95% CI (2.13-8.41)] (Model 1), TLC [p = 0.02, HR 1.81 95% CI (1.06-3.07)] (Model 2), ACLF grades [p = 0.018, HR 2.013,95% CI (1.126-3.60)], and CTP score [p <0.0001, HR 1.36 95% CI (1.17-1.59)] (Model 3). Conclusion: Serum ferritin levels correlate with severity of hepatic decompensation and are associated with early liver related death independent of the MELD score in hospitalized patients with decompensated cirrhosis. This could also have a potential therapeutic implication. (C) 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.